Healthy self-esteem for a start

April 11, 2011 at 5:01 pm Leave a comment

By Raj Cheema

Two months ago, I received a copy of the Public Service Review and, as usual, when I got back to the office, it was added to my existing pile of reading which tends to include ‘mental note to self: must read later this week’. Well, I finally managed to find some time – last week.

I found some of the articles in the review really interesting particularly the Secretary of State for Health’s ‘A healthy rebalance’ in which he outlines his vision of public health. Interestingly, his vision incorporates a re-think about the way in which people’s weak health is connected to their lack of self-esteem – something which he rightly states ‘you can’t legislate for’. Part of his vision for addressing this is:

‘to start seeing people and families as a whole using local voluntary and charitable organisation much more, cutting across boundaries, encouraging innovation, using the power of new technologies and new media, joining up professions and budgets and putting the heart of the strategy’.

Reading this article firstly reminded me of the Bromley by Bow Centre mentioned in Valerie Hannon’s ‘Next Practice’ in education: a disciplined approach to innovation’ booklet – as an innovative example for the provision of primary health care. The Centre is a community organisation. It’s a good example of holistic primary care provision for local communities – and not just providing for them – but engaging them. It connects health to a variety of factors like unemployment and loneliness and supports people in these areas to build their health and well being. In fact, I often wonder, given its success, why aren’t there more centres like this around the UK? Is it a question of scalability? If so, how will this vision help organisations like the Bromley by Bow Centre to replicate the model?

Secondly, I was surprised at how much money is spent in health care on two prevalent social challenges. Did you know that alcohol misuse costs society over £17 billion each year? And the figure for obesity is pretty similar too.

A colleague of mine suggested I read an article from The New Yorker called The Hot Spotters (I would highly recommend it – and I don’t recommend things often). The article draws upon the work of some innovative health care individuals who are completely re-thinking about the way in which healthcare needs to be provided for certain groups of people who form a small percentage of a local population but account for a major proportion of the total medical costs – and are starting to concern employers who have to pay up when the bills come through. For example, in one hospital, in a disadvantaged area in New Jersey, one percent of the users accounted for thirty percent of its costs! These innovative individuals are, arguably, taking a much more interventionist approach by shaping primary healthcare services that integrate a number of services to help these individuals get back on their feet (and there is definitely work here that helps them build their self-esteem).

Could a similar approach be applied in the UK in relation to our obesity and alcohol misuse challenges? If individual hospitals were to take a look at the patients who cost the state the most and shape services to help them – what kind of impact would this have on our public purse? I think the stuff that’s happening in the U.S. around this is really exciting – and we should definitely be paying attention and learning how this kind of data can be used to free the public purse for better integrated preventative services.


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